Tuesday, 30 April 2013

Revisiting REPOSE

This blog first appeared on the Diabetes UK blog site on 30th April 2013

It's been nearly three months since I started using my insulin pump as part of the REPOSE trial I'm taking part in, and I thought it was about time I did a bit of an update on how things are going.

I think the first thing to say is that whilst it's only been three months, it feels like a lifetime - and in a good way too.  You might recall that I was somewhat apprehensive about making the switch to a pump, a natural reaction to changing the way I've looked after myself for the last 10 years.  I'm happy to say that, at the moment, those fears were misplaced.

That's not to say that the transition was an overnight success, or that I've not had a few wobbles, but overall I feel like I've had a real, noticeable improvement in how I've felt which can't be a bad thing.

It's hard to say what exactly the cause of that is.  It would be easy to attribute it to the pump because that's the most obvious change, but there are a lot of other smaller changes I've made since I've been on the study which have probably had an effect.

Obviously I've attended a DAFNE course which, as I mentioned in a previous blog was an incredible experience and allowed me the time and opportunity to learn about some of the key things I'd either never been told, or had long since forgotten.  It was also really good to meet other people with type 1 and share some experiences.

I've also been recording my blood glucose levels, carbohydrate portions and insulin doses in a daily diary - something I've not done since I was diagnosed nearly 12 years ago.  I think that must be having some kind of effect as it lets me see the patterns over a few days rather than relying on memory which I've always done in the past.   A knock-on effect of that is that I'm testing my blood glucose more frequently than I ever have - from the dark days of a couple times a week a few years ago to at least five times a day now.  I take my testing kit with me everywhere now and that's certainly something I've never done before.

Having the pump gives me the ability to control my basal insulin more effectively and working through that process has been a real eye opener.  I wasn't previously aware of the "dawn phenomenon" (where your blood sugar can rise as you wake up) and going through periods of carb-free eating to understand what my basal levels should be showed me just how differently my body reacts to insulin at different times of the day.  Discovering I need to double my basal doses throughout most of the morning, just to stay level was a bit of a shock!

Whilst I do feel very comfortable with the pump (sometimes I genuinely forget I'm wearing it and panic that I've left the house without my insulin), I think it's worth looking at a couple of the 'negative' aspects of it as well.

Being wired up to something 24/7 is a constant reminder that you have type 1 diabetes (I joked recently that I'm effectively battery operated these days).  Whilst it's not something that particularly bothers me most of the time, it does make it a little harder to forget on the occasions that you'd like to.

On a daily injection regimen, there was always a small chance that you might inject somewhere that might mean the insulin didn't work as effectively as it should, but it was unlikely that would happen for every injection in a given day.  With the pump, as you place the cannula for three days a time, if you hit an ineffective injection site, all your insulin goes through there for a few days (unless of course, you notice, and change the cannula).  You also run the risk of the cannula not being inserted properly but that's possibly a story for another time.

The overall aim of the REPOSE study is to determine whether insulin pump therapy is more effective at treating people with type 1 diabetes.  Whilst I think it's a quite early to make any definitive statement, I know that so far I feel like it's had a positive effect on me so far and hopefully that will continue into the future.

Wednesday, 17 April 2013


This blog first appeared on the Diabetes UK blog site on March 26th 2013

Like many people, I have a love/hate relationship with exercise.  And like many people, I suspect I'm not the only one who finds the hardest part of it is actually getting up off the sofa in the first place.

My particular weapon of choice when it comes to exercising is running.  I remember thinking when I got diagnosed that it was the end of my dream of running the London marathon.  I couldn't see how I could manage something as complex as diabetes whilst doing something as gruelling as a marathon.

Thankfully my specialist care team at the time helped me see that diabetes doesn't have to be a barrier to things if you don't let it.  Whilst I'm sure he might already be one of the most famous diabetics, Sir Steve Redgrave is someone that probably personifies that attitude more than anyone else.

Training for a marathon is a pretty tough business as you can imagine and adapting that regime to take into account diabetes makes it that little bit more complex.  I started by working out a plan for how often I could expect to run.  I suffer from a few other, less glamourous, conditions (mild asthama and shin splints) that hampered me a bit but it gave me a place to start.

After that, I was back speaking to my specialist care team and trying to understand what effect my training plan would have on me.  This was back before I'd been on a DAFNE course so a lot of the information felt brand new (despite how long I'd been diabetic).

The upshot of it all involved running with one pocket full of jelly babies and the other with my blood glucose tester packed in a little plastic zip-lock bag so I could monitor how I was responding to the exertion.  Happily I found I could do about 10 miles before I needed an energy boost and that 4 jelly babies would get me about 4 miles.  That made running on the day a lot simpler!

I learned a few important lessons from that training which I think can apply to any kind of exercise you're thinking about:

  • Always have fast acting carbs with you.  I learned that one pretty quickly after having to abandon a run when I went unexpectedly low
  • Speak to your care team before you try something new, be it a marathon or any kind of physical activity. The hour I spent with a dietician made a world of difference
  • Monitor your BG.  I found that even having pretty good control before I started training, my routine mean things changed (e.g. my sensitivity to insulin at certain times) and monitoring is the only way to understand that
  • Don't be afraid to adjust your doses.  While I was on my two insulin regime, I'd never appreciated I could adjust my basal insulin (nor did I know by how much).  If you're doing lengthy exercise, this could help
  • Do some research - websites like Runsweet are packed with information and tips for all kinds of exercise
  • Make the most of the opportunity.  I was incredibly well supported and raised £1500 when I ran the London marathon.  If you're taking on any kind of challenge, then encouraging people to sponsor you can provide extra motivation for you whilst raising money for good causes.
I think the most important tip is to find something that works for you.  I know that running isn't for everyone but I genuinely believe that  20 minutes of something a couple of times a week not only makes you feel better but can have a significant impact on your quality of life as a diabetic.  I finished the year on an exercise bike in front of the TV as I couldn't run comfortably and that was just as good as dong miles on the pavements.

I'm happy to report that I completed the marathon last April in a respectable, if not earth shattering 5 hours 30 minutes (about 30 mins slower than I would have liked).  My plans for this year are a little more modest, but do include some unfinished business with the Sheffield Half Marathon in May (an injury training for that race in 2008 set me back a lot) as well as four 10km races.

As always, I'm raising money for DiabetesUK and The Children's Hospital Charity in Sheffield (specifically to raise funds for a summer camp for children with diabetes).  I'm aiming to raise £500 this year and if you'd like to contribute, you can do so by visiting my fundraising page (note all money is split 50/50 between the two charities)